STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

COGNITIVE BEHAVIOURAL THERAPIES

These incorporate the principles derived from the theory of behaviour, the theory of social learning and cognitive therapy, and involve a comprehensive approach to dealing with drug dependency problems, which basically consists of developing strategies aimed at increasing the person's control over their behaviour. Cognitive behavioural techniques used in drug dependence treatment include:

Coping skills training. The aim of this is to increase and reinforce the person's cognitive, behavioural, social and emotional skills to cope with high-risk situations. Practical strategies include training in skills to reject drug use, active listening, problem-solving, non-verbal communication, expressing feelings, assertiveness and anger management.

Relapse prevention. This is based on a specific theoretical model, (approach)^{1, 2, 3} according to which relapse occurs when the subject is exposed to a risk situation and is not able to respond with appropriate coping strategies to maintain their abstinence. The intervention is based on learning to identify situations, thoughts, emotions and signals that can lead to drug use and how to cope adequately to avoid relapse. This modality includes practical strategies, such as self-registration and functional analysis of drug use, strategies for coping with craving or differentiating between a "slip" (isolated use) and "relapse".

Contingency management. This is based on the fact that drug use is an operant behaviour maintained by its consequences and, therefore, modifiable. It consists of applying rewards or punishments according to the presence or absence of the target behaviour.⁴ These incentives are mostly used to reinforce abstinence, but also for other therapeutic goals, such as increasing attendance at treatment sessions or adherence to medication. The most widely used rewards include clinical privileges, access to employment or accommodation, and vouchers and discounts for goods or services in the community, conditional on abstinence from substances during treatment.

Community reinforcement programmes. These are based on providing the subject with contact with natural reinforcements from their social environment in order to increase the likelihood that they will remain abstinent. Strategies include tackling factors that can limit adherence to the treatment, work orientation for people without work and the selection of healthy alternatives.

Cognitive therapy.⁵ This ensures that the perception and structure of the individual's experiences continue to determine their feelings and behaviour. There is, therefore, a clear relationship between cognitions, emotions and behaviours. The stimuli that lead to drug use are found in the person's belief system, and can be detected and modified. The most widely used techniques include detecting automatic thoughts, classifying cognitive distortions, searching for evidence to confirm the validity of automatic thoughts, reallocation, decentration and the use of images.

Family and partner behavioural therapy. This focuses on improving communication skills and increasing positive reinforcement within family relationships.⁶ The most important strategies include functional analysis, behavioural contract, stimulus control, identification of conflicting family relationships that cause desire to use drugs or problem-solving training.

 

References:

1 Marlatt GA. (1993). Prevention of relapses in addictive behaviors: a cognitive-behavioural treatment approach. In M. Casas and M. Gossop (coord.), Relapse and prevention of relapses. Psychological treatments in drug addiction. Barcelona: Editions in Neurosciences, Citran. pp. 137-159.

2 Marlatt GA & Gordon JR. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviours. New York: Guilford Press.

3 Marlatt GA & Donovan DM. (2005). Relapse Prevention, Maintenance Strategies in the Treatment of Addictive Behaviours, 2nd ed. New York: Guilford Publications.

4 Higgins ST et al. (1991). A behavioural approach to achieving initial cocaine abstinence. American Journal of Psychiatry. 148: 1218-1224.

5 Beck AT, Wright FW, Newman CF, Liese B. (1993). Cognitive therapy of substance abuse. New York: Guilford.

6 Winters J et al. (2002). Behavioural couples therapy for female substance-abusing patients: effects on substance use and relationship adjustment. Journal of Consulting and Clinical Psychology. 70: 344-355.